Articulated hand brace

ABSTRACT

A hand brace secured to a patient&#39;&#39;s forearm including a support maintaining the patient&#39;&#39;s hand in an extended position. A connection between the portion of the brace fastened to the forearm and the support permits relative motions between the two along a path approximating the radial and ulnar paths of the patient&#39;&#39;s hand. A second joint permits relative motions of the hand support in up and down directions in combination with or instead of motions in the radial and ulnar directions. Thumb and finger guides for the patient are movably mounted to the hand support, engage the thumb and fingers of the patient and permit movement of the thumb and fingers towards and away from each other for the grasping and releasing of objects. Means responsive to up and down motions of the hand support move the finger guides.

United States Patent [1 1 Keropian 51 Jan. 2, 1973 [541 ARTICULATED HANDBRACE [22] Filed: Jan. 21, 1970 [21] Appl. No.: 4,646

[52] US. Cl. ..128/77, 128/26, 3/1, 3/12.4 [51] Int. Cl. ..A6lf 5/10[58] Field of Search .......128/77, 87-90, 128/26; 3/1-1.2, 12, 12.6,12.7, 12.4, 12.5; 272/67 [56] References Cited UNITED STATES PATENTS2,382,404 8/1945 Eberle ..3/12.6 3,020,908 2/1962 Daniels et al ..128/262,767,708 10/1956 Keropian ..128/77 2,553,277 5/1951 Robinson et al..3/1

FOREIGN PATENTS OR APPLICATIONS 502,687 2/1920 France ..128/77 112,2654/1918 Great Britain ..128/77 306,715 7/1918 Germany ..128/77 312,1035/1919 Germany ..128/77 OTHER PUBLICATIONS A Plastic Tenodesis Splint byC. L. Sabine et al., Journal of Bone & Joint Surgery, Vol. 47-A, No. 3,

April 1965, pages 533-536 Development of Useful Function In SeverelyParalyzed l-Iand" by V. L. Nickel et al., The Journal of Bone & JointSurgery,'Vol. 45-A, No. 5, July 1963, pages 933-943 relied upon.

Wrist Powers Fingers," Medical World News, Jan. 3, 1964, page. 25.

Primary ExaminerRichard A. Gaudet Assistant Examiner-Ronald L. FrinksAttorney-Townsend and Townsend [5 7 ABSTRACT are movably mounted to thehand support, engage the thumb and fingers of the patient and permitmovement of the thumb and fingers towards and away from each other forthe grasping and releasing of objects. Means responsive to up and downmotions of the hand support move the finger guides.

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ARTICULATED HAND BRACE BACKGROUND OF THE INVENTION Hand braces arewidely employed to support temporarily or permanently, partially orfully incapacitated or paralyzed hands of patients. Aside from providingsupport and preventing the patients hand from hanging loosely from thepatients arm such braces should prevent deformity and allow maximumfunction by providing guidance for the hand through its possible naturalmotions. Moreover, the braces should provide a therapeutic effect byutilizing all existing muscle function to help restore the hand to itshealthy condition to the greatest possible extent.

There are a variety of prior art hand braces which provide support forparalyzed hands and, to some extent, enable hand motions while the handis restrained to the support. Most conventional hand braces provide arigid or fixed support or only provide upward and downward motions ofthe hand which are not truly anatomical. Furthermore, such bracesprovide for only one motion up and down only, or side to side only, butnot a combination of all, including circumduction motions, in a trulyanatomical manner at the wrist joint. Additionally, prior art braces donot provide means for motoring or assisting weakened muscles in one ormore directions at the same time. Sideward motions in a radial or ulnardirection of a hand supported by prior art braces have generally notbeen possible because such motions are along a compound path that isdifficult to duplicate with mechanical braces. The usual provision of asimple pivot axis about which the hand support can move in the radialand ulnar directions results in a path for the hand support which doesnot conform to the natural path prescribed by the wrist joint so thatthe utility of such braces is limited or nonexistant.

Prior art hand braces usually lack means for conditioning and trainingor otherwise recapacitating these muscles since most hold the wrist in afixed position thus limiting treatment to relatively short therapeuticsessions while the wrist and hand remain passive between treatmentperiods.

SUMMARY OF THE INVENTION The present invention provides a hand brace forsupporting partially or fully paralyzed hands in general alignment withthe patients forearm. The hand brace permits movement of the hand in theradial and ulnar directions and/or in up and down directions so thatcircumduction motions of the supported hand are possible. The inventionincorporates means for biasing the supported hand in one or the otherdirections to thereby train partially paralyzed or weakened muscles andto utilize existing muscles in order to provide a continuoustherapeutical or functional effect. Means are also provided forpositioning the thumb of the supported hand and fingers thereof oppositeeach other and for moving them towards and away from each other inresponse to predetermined motions of the full hand to enable thegrasping and release of objects and render the hand useful even while itis in the brace.

In its broadest aspect the present invention provides a hand brace whichincludes means for securing the brace to the forearm of the patient anda support connected to the securing means for supporting the patientshand. Joint means connect the support to the securing means and permit agenerally arcuate, noncircular movement of the support in substantialconformity with movements of the patients hand in the radial and ulnardirections.

The brace preferably includes means between the securing means and thesupport permitting relative motion of the support in up and downdirections. To achieve the aforementioned muscle training spring meansare provided and connected to the securing means and the support forbiasing the support in one or the other direction or for centering thesupport in the alignment with the patients forearm for instances ofsevere weakness or total paralysis of the patients hand.

In one embodiment of the invention, the thumb and finger guides aremovably mounted to the hand support and position the thumb and fingersopposite each other. Means are provided for moving the guides towardsand away from each other in response to a predetermined motion of thehand support with respect to the securing means as actuated by theexisting muscles of the extensors of the wrist. This enables the use ofthe thumb and fingers, even if they are paralyzed, for grasping andreleasing objects. Preferably, the guides are articulated at about thepoint of the proximal and medial finger joints to enable frequentexercise of the joints and prevent them from stiffening due to nonuse.

The hand brace of the present invention provides guidance for a severelyweakened or paralyzed hand through motion paths which closelyapproximate the natural motion paths of the patients wrist, hand andfingers. The brace can thus be used in a truly functional manner withoutdiscomfort and loss of function as encountered in some prior art handbraces. The brace of the present invention enables the maximumutilization of the patients wrist, hand and fingers, even whenparalyzed, by further addition of motoring devices, e.g. cables,pistons, etc., to restore the afflicted hand to its maximum usefulnessand/or to prevent stiffness which results in attendant physiological andpsychological improvements of the patients condition. Moreover, the handbrace of the present invention enables the continuous training of theweakened or paralyzed hand to hasten the improvement, allow maximum handfunction and help achieve as much recovery of the hand as is possible.

The various embodiments of the hand braces described herein can bemanufactured so that the securing means, the joint means, and the handsupport means are interchangeable and the accessories for particularfunctions of the brace can be freely mounted thereto as required. Thissubstantially reduces the cost of the brace, since much lowerinventories are necessary to supply the demand.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a plan view of the handbrace constructed in accordance with the present invention and providedwith guides enabling the grasping of objects with the thumb and fingers,the hand being shown in phantom lines;

FIG. 2 is a side elevational view of the hand brace illustrated in FIG.1 and shows the finger guides in open position; I

FIG. 3 is a side elevational view similar to FIG. 2 but shows the fingerguides in a closed position;

FIG. 4 is a perspective plan view similar to FIG. 1 of a simplifiedembodiment of the invention; and

FIG. 5 is a side elevational view of the hand brace illustrated in FIG.4.

DESCRIPTION OF THE PREFERRED EMBODIMENTS To facilitate the understandingof the hand braces disclosed in the drawings and in the specificationthe following terms and expressions are clarified and given theindicated meaning.

The forearm is that portion of the arm of a human which includes theradius and ulna and the wrist is the area occupied by the carpal bones.The term hand is employed as descriptive of the metacarpal area andcomprises a palm, the back of the hand, the inner side from which thethumb extends and an opposite, little finger or outer side. The fingersof which the bones are phalanges are divided into three sections whichhinge at the knuckles and these sections will be referred to asproximal, medial and distal.

Starting from the anatomical position, the motions of the wrist relativeto the forearm are in the ulnar direction, that is motions of the handtoward the body;

in the radial direction, that is motions of the hand away from the body;up and down motions of the hand and the wrist, that is motions in thedirection of the back or with the forearm in a vertical direction asprescribed by the up and down motions of the hand.

Referring now to FIGS. 4 and 5, a hand brace 12 constructed inaccordance with a first, simplified embodiment of the invention for usein instances of radial nerve injuries or the like, in which all wristand finger extensors are paralyzed is illustrated. Brace 12 comprisessecuring means 14 for strapping the brace to a patients forearm 16, ahand support 18 and a joint 20 interconnecting the securing means andthe hand support. Joint 20 permits movements of support 18 along a pathgenerally coincident with the path prescribed by the hand moving fromits aligned position in the ulnar of radial directions (indicated byarrow 22).

The securing means comprises a generally H-shaped member 24 havingopposing pairs of arcuately formed legs 26 that extend part way aroundthe patients forearm. Straps 28, constructed of a flexible material 7such as leather or webbing, are riveted to the free end of one leg ofeach opposing leg pair, are wrapped around the patients forearm and arefastened to buckles 30 on the free end of the other leg of each opposingleg pair. Tightening of the straps securely fastens the securing meansto the patients forearm.

A generally V-shaped connector 32 extends from the forward end of theH-shaped member 24 towards the patients hand 34. A pair of guide bars35, 36 are pivotable about threaded bolts 38 which connect the bars tothe free ends of the V-shaped connector.

Hand support 18 comprises a main supporting member 40 which includes apair of arcuate, relatively long forward support bars 41, 42 and a pairof relatively short aft connection lugs 44. The outer forward supportbar 41 extends over substantially 180 so that it reaches under the palmof hand 34. The inner support bar 42 curves through about and terminatesin a substantially straight, downwardly extending portion 46.

A strap 48 is riveted to one of the aft lugs 44, wrapped around the palmportion of hand 34 and is secured to a buckle mounted to the other oneof the aft lugs.

A yoke 50 for connecting support 18 and securing means 14 is adjustablysecured to supporting member 40 via a bracket 52 and a set screw 54. Theyoke includes a pair of spaced apart openings (not separately shown)through which threaded bolts 56 extend. The bolts also extend throughbores (not shown) in guide bars 35, 36 and pivotally connect the freeends of the guide bars to the yoke. Thus, the yoke and guide bars securethe securing means to the hand support. The pivotal connections of theguide bars by bolts 38 and 56 enables relative movement of the handsupport with respect to the securing means through a path closelyapproximating the path prescribed by hand 34 when the hand moves in theradial or ulnar directions. To minimize friction during relativemovements between securing means 14 and support 18, low friction bearingplats 57, such as ball bearing discs as flat teflon washers, arepreferably disposed between the opposing faces of yoke 50, guide bars35, 36 and V-shaped connector 32 at the pivotal connections 38 and 56.

The exact spacings between the pivots defined by bolts 38 and 56 willvary from patient to patient. However, a'spacing of about 1 inch betweenthe axes of bolts 56, of about 2 /4 to about 2% inches between the axesof bolts 38, and a guide bar length between the a trough shaped supportbar 60 which has a sufficient width to enable the placement of the'patients fingers 62 thereon. The support bar is fastened to acantilever arm 64 that is adjustably secured to harid supporting member40 by a bracket 66 and a set screw 68.

A web spreader 70, preferably constructed of a nonabrasive, smoothmaterial such as plastic, is secured to the straight portion 46 of innersupport bar 42 with a mount 72 and a threaded bolt 74. The web spreaderhas a configuration and shape as illustrated in FIGS. 4 and 5. The webspreader mount 72 includes extensions 73 which embrace downwardlyextending portion 46 and permit slidable movement of the mount which isfixed and positioned by tightening bolt 74. This permits adjustments inthe spreader position ,to adapt the brace for use on hands of differingthickness.

For strength and durability the securing means, as well as the jointmeans and hand support 18 are preferably constructed of light weight,malleable metal such as soft aluminum. To prevent skin irritation whilethe hand brace is worn the surfaces of the brace facing the patientsforearm or hand are preferably padded with a suitable soft material 76such as felt, foam material, and the like.

Hand brace 12 is applied by slipping it over the aligned hand 34 andforearm 16 towards the patient so that the patients hand passes throughthe outer for-. ward supporting bar 41 until fingers 62 rest on fingerguide 58. Thereafter, straps 48 and 28 are wrapped about the patientshand and forearm, respectively, and tightened with the buckles to securethe hand support to the patients hand and the securing means to thepatients forearm. The weight of the hand is now transferred from thehand support'to the securing means via joint 20. Thus, in spite ofparalysis or unusability of the muscles for raising and lowering thehand, the latter is maintained in an extended position while jointpermits it to move in the radial and ulnar directions if muscle functionon the radial or ulnar side is present and are assisted or opposed bysprings.

Guide 58 provides support for the fingers. If the fingers are usable,the guide can be temporarily or permanently removed to enable the use ofthe fingers and the thumb of the patient. Finger paralysis, however,dictates the permanent retention of the phalangeal support.

Web spreader 70 abducts the thumb 78. Paralysis or damage to the thumbmusculature usually causes retraction of the thumb towards the palm. Tomaintain the thumb in an abducted or generally downward position of thefingers, web spreader 70 is used. If the thumb has a tendency to bendinward at the distal joint, a sling 80 is placed over the thumb andattached to a spring 82 secured to a mounting assembly 84 embracingstraight portion 46 of inner forward supportbar 42 in the same manner asmount 72 to provide adjustability. Spring 82 biases the sling, and withit thumb 78 in a clockwise direction, as viewed in FIG. 4, in oppositionto the thumbs tendency to contract inward. This positioning of the thumbprevents it from suffering flexion deformities and enables the use ofthe hands grasping function in instances where only'the thumb ispartially paralyzed and one or more of the remaining fingers remainusable.

In many instances of paralysis of the hand, the radial or ulnar musclesare weak or nonusable. This impairs or prevents movement of the hand inthe radial or ulnar directions. Under total paralysis the patient has nocontrol over the ulnar or radial deflection of the hand while underpartial paralysis, of either the ulnar or radial deflectors, forexample, the patient cannot return the hand once the hand is in adeflected position.

To aid the hand, the present invention provides means for maintainingthe hand in an aligned position when the ulnar and radial deflectors arenot usable. Referring again to FIGS. 4 and S, yoke 50 includes lips 86which extend outwardly from bolts 56 and include a pluralityof smalldiameter bores. A spring mount 88 is adjustabiy connected to theH-shaped member 24 of securing means 14 with a bracket and set screwarrangement. The spring mount also includes small bores into which oneend of a helical tension spring 90 is anchored. The other end of thespring is anchored in one of the small diameter bores in yoke lip 86. Asecond, identical helical tension spring (not shown in FIGS. 4 and 5) isanchored to spring mount 88 and the other yoke lip 86..The two springsexert equal forces and thus bias hand support 18 into a neutralposition. When the hand brace is applied to a paralyzed arm, the

helical compression springs maintain the hand support, and therewith theparalyzed hand in alignment with the patients forearm.

If only one of the radial or ulnar muscles is incapacitated, only onehelical tension spring 90 is applied to yoke 50 and spring mount 88 sothat hand support 18 is spring biased in opposition to the movementinduced by the working muscle. Should one of the ulnar or radial musclesbe substantially weaker than the other one, a helical tension spring canbe employed to aid the weaker muscle.

Referring now to FIGS. 1 through 3, a hand brace 92 constructed inaccordance with another embodiment of the invention is illustrated.Those portions of hand brace 92 which are identical with the hand braceillustrated in FIGS. '4 and 5 are given the same reference numerals asin FIGS. 4 and 5 are not again described except to the extent necessaryfor an understanding of the construction and operation of hand brace 92.

Hand brace 92 comprises securing means 14 for attachment of the brace tothe patients forearm 16, a hand support 18 and a joint 20 permittingrelative motion of the hand support along a path prescribed by thepatients ,hand when moving in the radial or ulnar direction. Hand brace92 includes second joint means 94 permitting up and down motion of thehand support means 18 and hand 34. Additionally, hand brace 92 is fittedwith thumb and finger guides 96, 98 actuated by a linkage 100 inresponse to a predetermined relative motion between the securing means14 and hand support 18. The thumb and both of the second and thirdfingers are thereby positively guided towards and away from each otherto enable the grasping of objects.

Hand support 18 includes outer and inner forward support bars 41, 42 andthe latter again terminates in a downwardly extending straight portion46. Aft lugs 44 of the hand support mount strap 48 for securing the handsupport to the patients hand in the above described manner.

The movable connection between the securing means and the hand supportis defined by joint means 20 including a yoke 102 pivotally secured tothe free ends of guide bars 35, 36 by a pair of spaced apart bolts 56.Yoke 102 includes a pair of downwardly curved legs 104 which extend overthe patients forearm in substantial alignment with the wrist jointbetween hand 34 and forearm 16. The lower ends of legs 104 are pivotallyconnected to a second, forward yoke 106 by conventional threaded bolts108 defining a pivot axis in substantial alignment with the pivot axisfor the hand for up and down motions of the hand. Forward yoke 106includes upwardly extending legs that span over the patients hand, meetat a center point and form a forwardly projecting tongue 110 adju'stablysecured to hand support 18 by bracket 52 and set screw 54.

Thus, hand support 18 is vertically pivotable with respect to securingmeans 14 about pivot bolts 108 and is movable in a general horizontalplane along a path defined by joint means 20. Low friction bearing meansare placed between the opposing sides of the yokes and guide bars in theabove described manner to minimize friction drag when the brace ismoved.

In use, hand brace 92 is applied to the patients hand in the same manneras is brace 12. The patient, however, can now move his hand withoutrestraint in all directions. To align the patients hand with his forearmwhen either one or both of the radial and ulnar musclesareincapacitated, one or two helical tension springs 90 are connected toyoke lips 86 of yoke 102 and a spring mount 112 secured to securingmeans 14. The tension springs bias the hand support 18 in one or theother direction or center it in alignment with the patients forearm.

In instances where the muscles for the raising and lowering of thepatients hand are incapacitated, so that the weight of the hand wouldcause hand support 18 to pivot about bolts 108, a helical tension spring114 is anchored to lugs 115, 116 projecting from yokes 102 and 106,respectively. The spring force biases the hand support about bolts 108in an upward direction in opposition to the weight of the patients handto maintain the hand extended and/or to aid the patient in raising hishand when his muscles are weak or imbalanced during a state of recovery.

Severe or fatal paralysis of the patients thumb and fingers usuallyrenders the hand useless for the duration of such paralysis. The presentinvention provides means for restoring at least partial utility to aparalyzed hand by utilizing the wrist extensor as a motor. The paralyzedthumb and fingers are activated by guides 96, 98 that force them towardsor away from each other to enable the grasping of objects such as a cube118 illustrated in- FIG. 2. Any function in the thumb abductors andfinger flexors assists the motoring of the device via a linkage 100.

Finger guide 98 is constructed for the simultaneous engagement of a pairof fingers, namely, the patients index and middle fingers, and comprisesa base 120 mounted to inner support bar 42 of hand support 18 by abracket 122 and a set screw 124. The bracket and set screw permitsadjustment of the finger guide for use in the varying finger lengths.The base extends forward of the support bar and a threaded bolt 126pivotally connects a center link 128 to the free end of the base. An endmember 130 of the finger guide is pivotally mounted to the outermost endof link 128 by a threaded bolt 132.

Referring particularly to FIGS. 1 and 3, center link 128 comprises aflat cover plate 134 integrally constructed with the link and extendingacross the width of the index and middle fingers where the cover plateterminates in a downwardly extending, generally U- shaped support bar136 for the fourth and fifth fingers of the patient (see particularlyFIG. 1).

Referring to FIGS. 1 through 3, end member 130 also includes a coverplate 138 (illustrated as demountably secured to the end member)extending across the width of the patients index and middle fingers andwhich terminates in a support bar 140 that projects downwardly and backtowards end member 130 substantially across the full width of the indexand middle fingers. A second support bar 142 issecured to the coverplate 138 adjacent a forwardmost end thereof and extends downwardly toprovide further guidance for the finger tips engaged by finger extensor98.

Referring now to FIGS. 2 and 3, linkage 100 is employed for pivoting thecenter link 128 and the end member 130 about pivot bolts 126, 132 inresponse to an upward motion of the hand support 18 with respect tosecuring means 14 whereby the index and middle fingers of the patientare forcibly bent at their respective knuckles. The linkage comprises abase 144 affixed to yoke 102 adjacent pivot bolt 108 to which an end ofa push bar 146 is pivotally connected as with a threaded bolt 145. Pushbar 146 extends forward and is pivotally connected at 147 to the upperend of an upright post 148 integrally constructed with center link 128.When the hand support is pivoted about bolt 108 in an upward directionpush bar 146 pivots center link 128 about pivot bolt 126 in a clockwisedirection as seen in FIGS. 2 and 3.

A connecting member 150 is secured to center link 128, or integrallyconstructed therewith (not shown), and mounts a center portion of arocker arm 152 for pivotal movements about a bolt 153. The upper end ofthe rocker arm is pivotally connected at 155 to an arcuate bar 154. Theother end of the arcuate bar is pivotally connected at 157 to a bracket156 secured to end member 130. Upon upward pivotal motion of the handsupport about pivot bolt 108, which pivots center link 128 about pivotbolt 126, arcuate bar 154 is retracted in an aft direction (towards thepatients body) by rocker arm 152 to thereby pivot end member 130 aboutpivot bolt 132 in a clockwise direction as viewed in FIG. 3. The medialand distal sections of the fingers restrained in finger guide 98 arethereby further bent about the medial knuckle as generally illustratedin FIG. 3 so that the fingers have a pronounced arcuate, inwardlycurving position.

The ring and little fingers rest on support bar 136 of center link 128.They are free 'to curve with the index and forefinger to a limitedextent since support bar 136 moves with center link 128. However, thering and little fingers are not forceably deflected about theirknuckles.

Still referring to FIGS. 2 and 3, thumb guide 96 comprises a restrainingmember 158 pivotally mounted to the straight portion 46 of inner supportbar 42 adjacent the lowermost end thereof by a pivot bolt 160 andterminating in a tubular'section 162 through which the patients thumbextends. A mounting bracket 164 is secured to the restraining member andis pivotally connected to the lower end of rocker arm 152 by a pivot pin165.-Pivotal movement of the hand support about pivot bolts 108 in anupward direction causes pivotal movement of the rocker arm in acounterclockwise direction, as viewed in FIGS. 2 and 3, and pivotallymoves the thumb restraining member 158 about pivot bolt 160 in a counterclockwise direction towards finger extensor 98.

When hand brace 92 is applied to a patient's arm and he moves his handin an upward direction whereby hand support 18 pivots about pivot bolt108, linkage 100 curves the fingers engaged by finger guide 98 in,-

wardly and, at the same time, moves the thumb and the completestraightening of all the fingers and the thumb by linkage 100 to therebymove the fingers and the thumb to a distal position and release anyobjects retained therebetween.

As illustrated in FIGS. 1 through 3, the members of linkage 100 eachinclude a plurality of spaced openings for placement of the respectivepivot points. This enables adjustment of the linkage to account formanufacturing tolerances and permits the use of the linkage for variousrelative wrist and finger guide positions while maintaining the spacingbetween the finger and the thumb substantially constant for a givenposition of the hand support with respect to the securing means.Furthermore, low friction bearing means (not separately shown) such asteflon washers, are placed between the opposing faces of the member oflinkage 100 and guides 96, 98 at pivot points 126, 132, 145, 147, 153,

155, 157, 160 and 165 to minimize friction forces developed by thelinkage and thus enable the use of the brace with relatively weak motormuscles and low tension springs.

To maintain the position of the hand with respect to the thumb andfinger guides 96, 98, a web spreader 166 is adjustably mounted to thestraight support bar portion 46 with a set screw 167 in the abovedescribed manner. Web spreader 166 is preferably a round bar and extendssufficiently across the width of the patients palm to prevent thepatients hand from sliding forward with respect to the thumb and fingerextensors.

lclaim:

l. A hand brace comprising: means for securing the brace to a forearm ofa patient, a support connected to the securing means for supporting thepatients hand, and joint means between the support and the securingmeans and permitting a generally arcuate, noncircular movement of thesupport in substantial conformity with radial and ulnar movements of thepatients wrist and hand, the joint means comprising pivot means attachedto the securing means and the support, the pivot means defining aplurality of substantially parallel, spaced apart pivot axes disposedessentially perpendicular to a plane within which said movements takeplace, and bar means interconnecting some of the pivot axes topositively define a motion path for the support which is in substantialconformity with the motion paths of the hand during radial and ulnarmovements.

2. A brace according to claim 1 including means biasing the supportabout the joint means in one direction.

3. A brace in accordance with claim 1 including guide means for engagingthe patients thumb and one of more of the patients fingers, meanspermitting movement of the guide means towards and away from each otherby moving the thumb and the fingers to place the thumb and the finger inproximal and distal positions, and means for moving the guide meansbetween the proximal and distal positions in response to a predeterminedrelative movement between the securing means and the support.

4. A brace in accordance with claim 3 wherein the guide means comprisesa pair of members secured to the support and pivotable about a pair ofpivot axes spaced to approximate the spacing between the patientsknuckles, and including means for positively moving the members aboutthe pivot axes to move the fingers to their proximal and distal relativepositions.

5. A brace for supporting a patients hand providing guidance for thewrist and hand for movement in at least the radial ar rd ulnardirections comprising: means for securing t e race to the patient 5forearm, a hand support, and means connecting the support to thesecuring means and permitting relative movements between the support andthe securing means along a path approximating the radial and ulnarmovement paths of the patients wrist and hand, the connecting meansincluding a pair of spaced apart first pivot means on one of the handsupport and the securing means, second pivot means on the other one ofthe hand support and the securing means, the first and second pivotmeans having substantially parallel axes, bar means connecting the firstpivot means with the second pivot means, and means permitting pivotalmovement of the bar means about the first and second pivot means.

6. A brace for a patients hand comprising: means for securing the braceto the patients forearm, a support for the patients hand, motionpermitting means connecting the support to the securing means, themotion permitting means including means defining a plurality ofunidirectional pivot axes on the support and the securing means, aplurality of bar means extending between the support and the securingmeans and interconnecting preselected ones of the pivot axes topositively guide the support through a relative motion path whichclosely resembles the relative motion path of a hand in the radial andulnar directions, guide means for positioning and holding the patientsthumb and fingers in opposing relation, and means connected to the guidemeans and the brace for moving both the thumb and at least one fingertowards and away from the other in response to relative movementsbetween the securing means and the support, whereby relatively largeobjects can be placed between the patients extended thumb and finger forgrasping and releasing by moving the patients wrist and hand withrespect to the forearm.

7. A brace in accordance with claim 6 wherein the guide means includesmeans for pivoting the guide means about a pair of spaced apart pivotaxes, and

wherein the means for moving the guide means includes means varying therate of the relative pivotal movement of the guide means at the twopivot points.

8. A brace in accordance with claim 6 wherein the guide means movingmeans is constructed to move the thumb and the finger simultaneouslytowards each other as the patients wrist and hand moves in an upwarddirection and to separate the finger and the thumb as the patients wristmoves in a downward direction and wherein the brace includes meansconnected to the securing means and the support biasing the support intoa raised position.

9. A brace in accordance with claim 6 including means permittingrepositioning of the finger guide means with respect to the support, andwherein the finger guide means moving means includes means permittingtheir adjustment in response to the repositioning of the finger guidemeans, whereby the spacing between the finger and the thumb guide meansremains substantially constant for a given relative position between thesecuring means and the support.

1. A hand brace comprising: means for securing the brace to a forearm ofa patient, a support connected to the securing means for supporting thepatient''s hand, and joint means between the support and the securingmeans and permitting a generally arcuate, noncircular movement of thesupport in substantial conformity with radial and ulnar movements of thepatient''s wrist and hand, the joint means comprising pivot meansattached to the securing means and the support, the pivot means defininga plurality of substantially parallel, spaced apart pivot axes disposedessentially perpendicular to a plane within which said movements takeplace, and bar means interconnecting some of the pivot axes topositively define a motion path for the support which is in substantialconformity with the motion paths of the hand during radial and ulnarmovements.
 2. A brace according to claim 1 including means biasing thesupport about the joint means in one direction.
 3. A brace in accordancewith claim 1 including guide means for engaging the patient''s thumb andone of more of the patient''s fingers, means permitting movement of theguide means towards and away from each other by moving the thumb and thefingers to place the thumb and the finger in proximal and distalpositions, and means for moving the guide means between the proximal anddistal positions in response to a predetermined relative movementbetween the securing means and the support.
 4. A brace in accordancewith claim 3 wherein the guide means comprises a pair of members securedto the support and pivotable about a pair of pivot axes spaced toapproximate the spacing between the patient''s knuckles, and includingmeans for positively moving the members about the pivot axes to move thefingers to their proximal and distal relative positions.
 5. A brace forsupporting a patient''s hand providing guidance for the wrist and handfor movement in at least the radial and ulnar directions comprising:means for securing the brace to the patient''s forearm, a hand support,and Means connecting the support to the securing means and permittingrelative movements between the support and the securing means along apath approximating the radial and ulnar movement paths of the patient''swrist and hand, the connecting means including a pair of spaced apartfirst pivot means on one of the hand support and the securing means,second pivot means on the other one of the hand support and the securingmeans, the first and second pivot means having substantially parallelaxes, bar means connecting the first pivot means with the second pivotmeans, and means permitting pivotal movement of the bar means about thefirst and second pivot means.
 6. A brace for a patient''s handcomprising: means for securing the brace to the patient''s forearm, asupport for the patient''s hand, motion permitting means connecting thesupport to the securing means, the motion permitting means includingmeans defining a plurality of unidirectional pivot axes on the supportand the securing means, a plurality of bar means extending between thesupport and the securing means and interconnecting preselected ones ofthe pivot axes to positively guide the support through a relative motionpath which closely resembles the relative motion path of a hand in theradial and ulnar directions, guide means for positioning and holding thepatient''s thumb and fingers in opposing relation, and means connectedto the guide means and the brace for moving both the thumb and at leastone finger towards and away from the other in response to relativemovements between the securing means and the support, whereby relativelylarge objects can be placed between the patient''s extended thumb andfinger for grasping and releasing by moving the patient''s wrist andhand with respect to the forearm.
 7. A brace in accordance with claim 6wherein the guide means includes means for pivoting the guide meansabout a pair of spaced apart pivot axes, and wherein the means formoving the guide means includes means varying the rate of the relativepivotal movement of the guide means at the two pivot points.
 8. A bracein accordance with claim 6 wherein the guide means moving means isconstructed to move the thumb and the finger simultaneously towards eachother as the patients wrist and hand moves in an upward direction and toseparate the finger and the thumb as the patient''s wrist moves in adownward direction and wherein the brace includes means connected to thesecuring means and the support biasing the support into a raisedposition.
 9. A brace in accordance with claim 6 including meanspermitting repositioning of the finger guide means with respect to thesupport, and wherein the finger guide means moving means includes meanspermitting their adjustment in response to the repositioning of thefinger guide means, whereby the spacing between the finger and the thumbguide means remains substantially constant for a given relative positionbetween the securing means and the support.